Central Ohio Metal Detecting Association

MEMBERSHIP APPLICATION

Name __________________________________________________________________

Address ________________________________________________________________

City, State, Zip ___________________________________________________________

E-Mail Address __________________________________________________________

Home Phone _____________________________________________________________

Mobile Phone ____________________________________________________________

Emergency Contact Name __________________________________________________

Emergency Contact Phone __________________________________________________

Buckeye Treasure Hunter Forum Nickname ____________________________________

How did you find out about the Association? ___________________________________

For Member Referral Reward, please give the name of the member who referred you:

_______________________________________________________________________

A) Full membership dues (per calendar year) ____ x $25 = _______

B) Secondary membership for spouse/domestic partner* ____ x $15 = _______
C) Children of a member (under age 18)* ____ x $10 = _______
FMDAC Membership for Secondary member or child ____ x $5 = _______
Optional - Regular Mail Service ____ x $12 = _______
TOTAL _______

No refunds are given for membership dues for any reason. Members are responsible for any fees charged
to the Association for any checks or payments not honored by the bank.

All communication with the club will be done electronically through e-mail and the COMDA website. If a
member requires meeting notices and other communications to be prepared mailed via the Postal Service,
there will be additional $12/year surcharge to the membership fee.

*Please complete a separate Membership Form and Waiver for each membership, payment information
only needs to appear on the primary member’s application.

Office Use Only

Number __________________ Amount Paid _______________ Method _________________

Membership Card __________ Regular Mail ______________ FMDAC ________________

 Central Ohio Metal Detecting Association
WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

1. I hereby release, waive, discharge and covenant not to sue the Central Ohio Metal
Detecting Association, its officers, servants, agents and members (hereinafter referred to as
"releasees") from any and all liability, claims, demands, actions and causes of action whatsoever
arising out of or relating to any loss, damage or injury, including death, that may be sustained by
me, or to any property belonging to me, whether caused by the negligence of the releasees, or
otherwise, while participating in the Association meetings or outings, or while in, on or upon the
premises where the meeting is being conducted, while in transit to or from the premises, or in any
place or places connected with the Association.

2. I am fully aware of risks and hazards connected with participating in Association

activites, and I am fully aware that there may be risks and hazards unknown to me connected with
being on the premises and participating in Association activities, and I hereby elect to voluntarily
participate in the Association activities, to enter upon the specified premises and engage in
activities knowing that conditions may be hazardous, or may become hazardous or dangerous to
me and my property. I voluntarily assume full responsibility for any risks of loss, property
damage or personal injury, including death, that may be sustained by me, or any loss or damage
to property owned by me, as a result of my being a participant in the Association, whether caused
by the negligence of releasees or otherwise.

3. I further hereby agree to indemnify and save and hold harmless the releasees and each of
them, from any loss, liability, damage or costs they may incur due to my participation in the
Association, whether caused by the negligence of any or all of the releasees, or otherwise.

4. It is my express intent that this Release shall bind the members of my family and spouse,
if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be
deemed as a Release, Waiver, Discharge and Covenant Not to Sue the above named releasees.

In signing this release, I acknowledge and represent that:

A. I have read the foregoing release, understand it, and sign it voluntarily as my own free act
and deed;
B. No oral representation, statements or inducements, apart from the foregoing written
agreement, have been made;
C. I am at least eighteen (18) years of age and fully competent; and
D. I execute this Release for full, adequate and complete consideration fully intending to be
bound by same.

In witness whereof, I have hereunto set my hand and seal this ___ day of ____________, _____.

Signature: ___________________________________________

Name Printed: ___________________________________________

Witness: ___________________________________________
Witness
Name Printed: ___________________________________________